Acad Radiol. 2026 Mar 18:S1076-6332(26)00119-4. doi: 10.1016/j.acra.2026.02.031. Online ahead of print.
ABSTRACT
RATIONALE AND OBJECTIVES: Coronary artery disease is associated with cognitive and neuropsychiatric dysfunction through mechanisms that remain poorly understood. The glymphatic system-a cardiac-driven brain clearance network-may provide a mechanistic link. This study examined whether perivascular diffusivity DTI-ALPS differs between coronary disease patients and controls, correlates with disease severity and symptoms, and responds to revascularization.
METHODS: This cross-sectional study with seven-day post-revascularization follow-up enrolled 90 coronary artery disease patients and 90 matched controls. DTI-ALPS indices were calculated from 3.0 T MRI to assess periventricular water diffusivity. Cognitive function (Mini-Mental State Examination, Montreal Cognitive Assessment), fatigue (Fatigue Severity Scale), and depression (Hamilton Depression Rating Scale) were evaluated. Cardiac disease severity was quantified using myocardial perfusion imaging. Bootstrap mediation analysis examined whether DTI-ALPS statistically accounted for cardiac-symptom associations.
RESULTS: Coronary artery disease patients demonstrated reduced DTI-ALPS indices compared to controls (1.28±0.21 vs 1.38±0.18, P=0.001, Cohen’s d=0.52). DTI-ALPS correlated with cognitive screening performance (r=0.298-0.341, P<0.01) and symptom severity (r=-0.278 to -0.325, P<0.01). Mediation analysis revealed that reduced DTI-ALPS statistically accounted for 14.7-16.8% of cardiac-symptom associations (all bootstrap 95% confidence intervals excluded zero, P<0.05). DTI-ALPS demonstrated dose-response relationships with diseased vessels and myocardial perfusion deficits. Following revascularization, DTI-ALPS increased (P=0.013) alongside trends toward mood improvement, although neuropsychological screening measures did not reach statistical significance.
CONCLUSION: Reduced periventricular diffusivity assessed by DTI-ALPS is associated with both coronary artery disease and neuropsychiatric symptoms, statistically accounting for a modest proportion of their association. These cross-sectional findings suggest potential cardiac-brain clearance pathway connections that require prospective validation.
PMID:41856818 | DOI:10.1016/j.acra.2026.02.031
